On Tax Day, some will see how Obamacare will affect them

Medicine is squeezing all it can out of the dollar

Last Updated Apr 14, 2013 7:26 PM EDT

For most lower- and middle-income taxpayers in need of health insurance, the most significant tax-related aspect of Obamacare starts this year: calculating subsidies.

After filing his or her 2012 tax return, an uninsured taxpayer should find out whether they qualify for a government subsidy, and if so, how large it will be. That Tax Day development will help them make a key choice this fall: whether to take that subsidy and buy insurance coverage for 2014, or pay a fine to the IRS in 2015.

In 2014 alone, the government is expected to spend $25 billion on subsidies to help people purchase coverage on the state-based health exchanges -- the online marketplaces where consumers can choose from various private insurance plans. The exchanges are expected to be ready for open enrollment by October of this year.

Getting customers to join the exchange -- and thus expanding health care coverage, the Affordable Care Act's key objective -- requires the coordination of the Internal Revenue Service, Health and Human Services and other government agencies. The government is expected to collect more than $1 trillion in tax revenue over 10 years and dole out more than $1 trillion in subsidies.

"This is a major new venture and like anything, no one can predict exactly how it's going to work," Paul Van de Water, a senior fellow at the Center on Budget and Policy Priorities, explained to "The HHS and the IRS and other agencies involved in this are working hard to implement it, but until the thing actually starts, no one's really going to know what features need to be modified to make them work better."

Most of the tax-related elements of the Affordable Care Act don't impact taxpayers directly -- they instead impact business sectors like the medical device industry or health insurers. Still, some Americans will start noticing through their 2012 tax return how Obamacare impacts their lives. And starting this year, others will be paying extra taxes because of the law.

Calculating subsidies

Subsidies for the exchange will be available to individuals with household incomes between 100 and 400 percent of the Federal poverty level -- taking into account factors like family size.

By 2022, according to the nonpartisan Congressional Budget Office, an estimated 26 million people will get their insurance through state exchanges. Up to this point, however, most people don't understand how the health care law will impact them directly or what their taxes have to do with it.

After finding in a survey that 77 percent of respondents were unaware their 2012 tax return could be used to determine their first year of subsidies, H&R Block started conducting customer outreach on the subject. When the company's tax preparers sit down with customers, "a lot of them are relieved and excited to the see the Affordable Care Act broken down into how it personally affects them," Meg Sutton, a senior advisor for tax and healthcare services at H&R Block, told

Open enrollment for the exchanges is supposed to start in October of this year, with coverage starting in 2014. If a taxpayer qualifies for a subsidy, he'll enroll in a private health plan through the exchange, the government will pay the subsidy directly to the insurer and the taxpayer has to cover the remaining cost.

If a taxpayer takes a subsidy, he's required by law to report that to the IRS the next year. The IRS will review it and decide, based on that person's income, whether he received too much or too little in subsidies. "If you got too much of a subsidy, consumers will see money coming out of their refund," Sutton explained.